Fluid 3

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Author:
jld15
ID:
303486
Filename:
Fluid 3
Updated:
2015-05-31 21:15:41
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Fluid
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Fluid 3
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  1. Hypercalcemia info
    • Causes: increased calcium from bone, decreased excretion of calcium
    • Clinically: lethargy, coma, weakness/flaccidity, n/v, constipation, ARF (acute renal failure), EKG changes
    • Treat: IVF fluids, phosphates, decrease calcium intake, increase mobility do calcium doesn’t get leached from bone
    • ----Depresses the system
  2. Hypocalcemia
    • Causes: diuretics, lack of vit D, sepsis (body wide infection), pancreatitis, liver disease
    • Clinically: weakness, muscle spasms, ileus (paralyzation of the bowel), mental status changes, EKG changes, neuromuscular irritability, and shallow resp.
    • Treat: calcium chloride, calcium gluconate
    • ----Irritates the system
  3. Hypermagnesemia (rare) info
    • Causes: renal failure, excessive mag intake (antacids - Tums)
    • Clinically: bradycardia, decreased RR, drowsiness
    • Treat: IV calcium gluconate, hemodialysis
    • ----Things depressed
  4. Hypomagnesemia info (more common in acutely ill)
    • Causes: CRF (chronic renal failure), pancreatitis, cirrhosis, ETOH (alcohol) abuse, GI losses
    • Clinically: tetany, seizures, EKG changes
    • Treat: IV or PO mag replacement
  5. Management of electrolyte imbalances
    • ECG changes
    • ----K
    • ----Ca
    • ----Mg
    • Medical management is to look for cause and correct it
    • ----We don’t correct electrolyte imbalances
    • Remember vital signs!
  6. Common Causes of Imbalances
    • Tissue injury
    • ----Burns
    • Surgery
    • Trauma
    • Diabetes mellitus
    • ----DKA: diabetic ketoacidosis: increase production of keytones: part of break down of fat
    • Malignant tumors
    • ----Paraneoplastic syndromes
    • --------Some tumors excrete peptides that directly alter electrolytes
    • --------Can also be indirect
    • ------------Chemo/radiation: cause fluid loss, nausea, vomiting
    • Alcohol withdrawal
    • Eating disorders
    • ----If not eating not getting enough electrolytes
    • Skin
    • ----Poor skin turgor
    • ----Temperature changes
    • --------Cool pale too much fluid
    • --------Not enough fluid: warm/red
    • ----Edema
    • Neuromuscular
    • ----Muscle fatigue
    • ----Twitching
    • ----Cramping
    • ----Tetany
    • CNS
    • ----Changes in DTR’s
    • ----Convulsions
    • ----Depression
    • ----Memory impairment
    • Vital Signs
    • ----Tachycardia
    • ----Postural hypotension
    • ----Altered respirations
  7. Deep Tendon Reflexes hyperactive
    • Hypocalcemia
    • Hypomagnesemia
    • Hypernatremia
    • Hyperkalemia
    • ----More commonly hyper active, sometimes hypo
    • Alkalosis
    • Dehydration
  8. Deep tendon reflexes Hypoactive
    • Hypercalcemia
    • ----Everything depressed
    • Hypermagnesemia
    • ----Everything depressed
    • Hyponatremia
    • Hyperkalemia
    • ----More commonly hyper active, sometimes hypo
  9. Acidosis
  10. Assessment of Imbalances
    • Head and neck
    • ----Edema versus dry mucous membranes
    • Extremities
    • ----Dependent edema versus muscle weakness, tingling, tetany
    • Skin
    • ----Warm, moist, cool versus dry with decreased turgor
    • Circulation
    • ----Hypertension versus hypotension
  11. Acid- Base Balance Mechanisms
    • Buffer system- immediate, not long lasting, plasma proteins
    • Respiratory- works over hours, regulates pCO2
    • Metabolic- works over days, kidneys regulate bicarb (HCO3-)
    • ----Main way
  12. Normal ABG (arterial blood gas)
    • pH: 7.35-7.45 (a little alkalinic)
    • pCO2: 35-45 mmHg
    • PaO2: >60 mmHg
    • HCO3-: 22-26
  13. Acidosis
    Primary cause
  14. Acidemia
    Don’t know cause

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